A Colorful Way to Prevent Diabetes: A “Berry” Good Idea

April J. Stull, PhD, RD

Botanical Research Center Pennington Biomedical Research Center

Louisiana State University System

Diabetes

Fighting Diabetes

Blueb

erry

Defeating Diabetes

Outline

• Diabetes• Dietary Supplements• Blueberries

– Literature Review– PBRC human research Study

Obesity and Diabetes Trends Among U.S. Adults

Obesity (BMI ≥30 kg/m2)

Diabetes

1994

1994

2000

2000

2007

2007

No Data <14.0% 14.0-17.9% 18.0-21.9% 22.0-25.9% >26.0%

No Data <4.5% 4.5-5.9% 6.0-7.4% 7.5-8.9% >9.0%

CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics

Interventions Used to Delay the Progression to Type 2 Diabetes

Diet Modification

Physical Activity

MedicationComplementary and

Alternative Medicines (CAM)??

10 Most Common CAM Therapies (2007)

Natural Products

Deep Breathing

Mediation

Chiropractic and Osteopathic

Massage

Yoga

Diet-Based Therapies

Progressive Relaxation

Guided Imagery

Homeopathic Treatment

0 2 4 6 8 10 12 14 16 18

17.7

12.7

9.4

8.6

8.3

6.1

3.6

2.9

2.2

1.8

Nonvitamin, Nonmineral, and Natural Products

PercentBarnes, PM et al., National Health Interview Survey, 2007

Botanical Dietary Supplement

• Is a plant or plant part dietary supplement valued for its medicinal or therapeutic properties, flavor, and/or scent

• Dietary Supplement– Is intended to supplement the diet– Contains one or more dietary ingredients– Is intended to be taken by mouth as pill,

capsule, tablet, or liquid– Is labeled on the front panel as being a dietary

supplement

Botanical Dietary Supplements

• Products made from botanicals that are used to maintain or improve health may be called:– Botanical products– Herbal products– Phytomedicines

Out-of-Pocket Costs for CAM Among US Adults, 2007

12%

8.7%

0.6%

35.2% Botanical Dietary

Supplements

Yoga, Tai, Chi, Qigong Classes

Relaxation Techniques

Homeopathic Medicine

Practitioner Costs

Total Costs: $33.9 billion

Nahin RL et al., National Health Interview Survey, 2007

$11.9 billion 43.7%

14.8 billion

Botanical Dietary Supplement “BLUEBERRIES”

U.S. Blueberry Consumption Per Person

1 2 30

5

10

15

20

25

13

22

Year

Ou

nc

es

19971997 20072002

United States Highbush Blueberry Council; Available at www.blueberry.org

70% consumption increase from years 1997 to 2007

Blueberries Are Everywhere!!!

Blueberries

• Blueberries provide health benefits for many different conditions / diseases– Heart– Vision– Cancer – Diabetes

Antioxidant Activity

0

2000

4000

6000

8000

10000

12000

Berries

An

tio

xid

an

t A

cti

v-it

y

USDA, ORAC of Selected Foods, 2007

Definitions

• Glucose (blood sugar)– Sugar in the blood that is used for energy

• Insulin– A hormone that controls the amount of

glucose in the blood– Produced from the pancreas

Definitions

• Insulin sensitivity– Insulin efficiently moves glucose from the

bloodstream to the cells in the body– Cells inside the body respond to the action

of insulin

• Insulin resistance– Insulin has difficulty moving glucose from

the bloodstream to the cells in the body– Cells inside the body DO NOT fully

respond to the action of insulin

Blueberries as a Therapy for Type 2 Diabetes

• Literature Review– Blueberries are a folk remedy in Canada for

treatment of diabetes (Martineau LC et al., Phytomedicine, 2006)

– Blueberries have been found to:• Reduce blood glucose concentrations in rats and

humans (Abidov M et al, 2006 ; DeFuria J et al, 2009)

• Increase glucose uptake in muscle and fat cells (Vuong T et al, 2006)

• Protect against obesity in rats (DeFuria J et al, 2009)

Humm….Can blueberries improve pre-diabetes and prevent diabetes in humans?

PBRC Blueberry Research Study

• Primary Objective– To evaluate the effect of blueberries on

improving the ability of insulin to work in pre-diabetic individuals

• Hypothesis– Dietary supplementation with blueberry

smoothies will result in an increase in the ability of insulin to work in pre-diabetic individuals

Study Design

Baseline

Blueberry Smoothie

Placebo Smoothie

Screening

Insulin Sensitivity Test

1 2 3 4 5 6 7 8 9 10

End

End

Visits (Weeks)

*Randomized

*Started consuming smoothies

Insulin Sensitivity Test

Measures the ability of insulin to move glucose (or blood sugar) from the bloodstream to the cells

Study Design

WeeksStudy Parameters 1 2 3 4 5 6 7 8 9 10Randomization Blood Pressure/Body Weight Blood and Urine Samples Physical, Heart Function, and Body Fat Exam

Oral Glucose Tolerance Test Insulin sensitivity Test Nutritional Assessments Food Frequency Questionnaire 3-Day Food Records Fruit/Wine Questionnaire Smoothie Taste/Ratings Test Smoothie Pick-up

Nutritional Value of Smoothies

Nutritional Value (per 16oz) Blueberry PlaceboEnergy, kcal 239 234Carbohydrate, g 48.5 48.6 Fiber, g 4.2 4.3Protein, g 11.9 11.1Fat, g 0.08 0.08 Saturated Fat, g 0.05 0.05

Each participant consumed two 16oz smoothies per day (Total 32oz)

Blueberries provided (per 16oz smoothie): 80 kcal , 20g carbohydrates, 4g fiber, 0.8g protein, 0g fat

Vitamins and minerals: calcium, magnesium, phosphorous, potassium, folate, vitamin C, A, E, and K

16 ozBlueberry Smoothie

=1 cup of blueberries

Variables Blueberry Placebo

n=15 n=17Race African American 8 8 Caucasian 9 7Gender Male 2 3 Female 13 14Age, year  54  49Body weight, kg 99 103BMI, kg/m² 37 38Body fat, % 41 42

Characteristics of The Study Participants

The Ability of Insulin to Work in All ParticipantsFrom Beginning to End of Study

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32-30

-20

-10

0

10

20

30

40

50

60

70

80

90

100

Subject Numbers

% ∆

In

suli

n S

ensi

tivi

ty

Blueberry Placebo

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

Blueberries Improved the Ability of Insulin to Work

Blueberry Placebo 0

5

10

15

20

25 22.2

4.9

%∆

In

suli

n S

ensi

tivi

ty

∆ insulin Sensitivity = ability of insulin to work from week 0 to week 6

Consuming Blueberries Did Not Affect:

Food intake

Body weight

%Body fat

Conclusions

• Blueberry smoothies improved the ability of insulin to work in pre-diabetic individuals

• The blueberry smoothie did not affect body weight and energy intake

Yummy…

Future Research

2nd Blueberry Study Evaluate the effects of blueberries on

high blood pressure and heart health*****will start RECRUITING soon!*****

We need your

help!!

For More Information About Blueberries

United States Highbush Blueberry Councilhttp://www.blueberry.org

Blue Harvest Farmshttp://www.blueharvestfarms.com

Nutrition Informationhttp://www.lsuagcenter.com/en/food_health/nutrition

http://www.lsuagcenter.com

http://www.lsuagcenter.com/en/food_health/nutrition

http://redstickfarmersmarket.org

http://www.herbsociety.org

Thank You

Acknowledgements• William Cefalu, MD• William Johnson, Ph.D• Catherine Champagne, PhD, RD, LDN• Katherine Lastor, RD, LDN• PBRC inpatient and outpatient unit staff• Metabolic kitchen staff• PBRC Botanicals Research Center• United States Highbush Blueberry Council• Cefalu’s Lab• Participants